Factors Associated With Oral Epithelial Dysplasia in Oral Potentially Malignant Disorders: Who 5th Edition Criteria

Potentially malignant disorders (PMDs) carry an increased risk of malignant transformation, which may vary according to patient-specific characteristics. The purpose of this study was to measure the association between sociodemographic and clinical characteristics and oral epithelial dysplasia (OED) among patients with PMDs. This retrospective cross-sectional study included participants with PMDs evaluated between 2005 and 2019 at Antônio Pedro University Hospital, Universidade Federal Fluminense, Brazil. Exclusion criteria included lesions not compatible with PMDs after clinical and histopathological review, malignant lesions, lesions associated with candidiasis or trauma, and those located on the lip vermilion. The predictor variables were a heterogeneous set of sociodemographic and clinical characteristics. The main outcome variable was OED categorized as absent, mild, moderate, or severe. Not applicable. Associations between sociodemographic and clinical variables and OED were assessed using chi-square or Fisher’s exact tests, as appropriate. Bivariate analyses estimated relative risks (RR) with 95% confidence intervals (95% CI), with statistical significance set at p≤0.05. The sample comprised 60 participants (mean age 58.9 years ±12.4; 51.7% female). The most frequent PMD was leukoplakia (73.3%), followed by leukoerythroplakia (18.3%), proliferative verrucous leukoplakia (PVL, 6.7%), and erythroplakia (3.3%). All participants presented OED, classified as mild in 53.3%, moderate in 30.0%, and severe in 16.7%. Overall, PMD type was not associated with OED severity (p=0.2); however, leukoplakia was associated with lower-grade OED (p=0.04). In bivariate analysis, leukoerythroplakia showed a higher risk of moderate/severe OED compared with leukoplakia (RR=1.81; 95% CI: 1.04–3.14; p=0.04), and PVL showed a borderline increased risk (RR=1.94; 95% CI: 0.99–3.82; p=0.05). Sociodemographic variables and addictive habits were not associated with OED severity. Clinically, lesion location on the floor of the mouth was observed exclusively among cases with moderate/severe OED (p=0.03), and lesion heterogeneity showed a borderline association with moderate/severe OED (p=0.05). Although PMD type was not globally associated with OED severity, leukoplakia was linked to lower-grade OED, whereas leukoerythroplakia and PVL tended to show higher OED severity. Lesion heterogeneity and involvement of the floor of the mouth emerged as the most relevant clinical features related to moderate/severe OED, highlighting their relevance in the risk stratification of PMDs.